Photograph by Michael Amsler
straight-ahead help: Jess Wolfe is one of three staffers who runs the Russian River Empowerment Center.
Sonoma County's mental health system is nothing but crazy-making
By Lois Pearlman
The Russian River Empowerment Center occupies a simple, two-story house a block behind Guerneville's Main Street. To reach it from the west corner, you have to step into the narrow roadway to avoid a puddle--inexplicable in the middle of a drought--and the neighbor's red canoe.
The hand-painted green-and-white sign and the small reception desk by the front door signify that it isn't a private residence anymore. Otherwise, it seems like a family home. Inside, depending upon the time of day, a couple of people might be sitting on sofas waiting for a class, somebody might be cleaning up the kitchen after lunch or perhaps a small group will be seated around the redwood table on the back deck, enjoying a quiet conversation.
In the middle of a mental healthcare landscape fraught with frustration, controversy and compromises that satisfy no one, the Empowerment Center is an oasis of serenity.
"Everyone who comes here says, 'Oh, it's so calm,'" agrees Jess Wolfe, one of three staff members who run the center.
Wolfe, like colleagues Mary Black and Deanne Rocchietti, is a current or former mental healthcare consumer. Wolfe is a child-abuse survivor who has healed herself through a combination of traditional and alternative therapies. Her position as program coordinator at the center, she says, suits her perfectly because she has a lot of hard-won expertise to share.
The center is open Tuesdays through Fridays, offering a full schedule of support groups, dance, writing and stress reduction workshops, potluck lunches and beach hikes. There are also little self-guided stations set up with materials and suggestions for drawing and painting, writing and deep-breathing exercises. But mostly it is a safe place to spend some time, prepare a snack or meal in the fully supplied kitchen and cut through the isolation that surrounds many people who live with mental illness.
"A lot of what we do here is about relationships," says Wolfe, her face beaming with happiness. "I've been homeless. I've been on welfare. We can all offer each other a different perspective or a way out of the mess we're in."
One of the regular members, Russian River resident Leah Clark, agrees.
"It's about changing life's stories. We've had some real breakthroughs," she says.
The operating premise at the center is that people with mental illness are more than just their condition. And the center's goal is to help people live full, productive lives.
There are 55 regular members of the center with an average of about 12 participating each day. All of the activities are free to anybody who wants to participate, whether or not they have an official diagnosis of mental illness. There are monthly meetings and basic rules of conduct to ensure that everyone is safe.
At What Cost Health?
Of course, all of this comes at a cost, which is currently covered by a grant from the state Mental Health Services Act (MHSA), approved by voters in 2004 as Proposition 63.
The act, funded by a 1 percent tax on Californians earning more than $1 million annually, poured $3.5 million into Sonoma County mental health services during the 2006-2007 fiscal year. Statewide, the total is about $1.2 billion per year, more than originally anticipated.
That might seem like peanuts considering that Sonoma County budgeted $47 million last year for its mental health programs, but as state and federal budgets get tighter every year, it is still significant.
In its first phase, the MHSA has provided Sonoma County with money for two peer-operated wellness centers, outpatient treatment for 50 offenders with mental illness through the county's Mental Health Court and additional services for children, teens, families, adults and seniors, homeless people and substance abusers. Under the act's provisions, at least 50 percent of the money has to be spent on partnerships with nongovernmental agencies.
In addition to the cash infusion, which cannot be diluted by budget deficits, the act also sets out other provisions that make it unique. The framers of Proposition 63 included a requirement that all of the programs funded with the money must be new. That means that counties can't use the money to supplement existing standard programs, potentially opening the door to new ways of doing things.
The MHSA also provides money to fund a planning process for each phase, a process that is open to the public. The first chunk of the money is designated for services; the second phase for prevention and early intervention. Smaller portions of the money are designated for innovations, capital facilities and technology, education and training.
Beginning in 2004, the county held dozens of meetings to determine how to spend the services portion of the money. Currently, it is in the middle of planning sessions for the prevention and intervention phases.
"The hard part of this is that the community is going to have to identify priority groups and priority approaches," says Mike Kennedy of the Sonoma County Mental Health Department. "The trick is, do you want to go a mile wide and 12 inches deep, or do you want to really focus?"
It's a tough question when there are so many gaps in the county's mental health services. One of the big holes already identified is the lack of intervention programs for youngsters who exhibit early signs of mental illness.
If a program were already in place, it's possible that Sebastopol teen Jeremiah Chass might still be alive. His family might have had the resources to help him before he had a March 2007 episode of mental decompensation and was shot to death by sheriff's officers in his own driveway.
With at least two other police killings of mental health patients in less than a year, the county is experiencing a mental health crisis of its own. Families of two of the victims have filed suit in federal court. Chass' family is suing the Sonoma County Sheriff's Department, and both the wife and mother of the late Richard De Santis, a bipolar man killed by police in September 2007, are suing the Santa Rosa Police Department.
Point Arena resident Valerie Barber, whose mentally ill son Jesse Hamilton was killed by Santa Rosa police in January, says that he had been released too soon from a halfway house into a group home with minimal supervision and was unable to take care of himself. Hamilton had stopped taking his medication and was allegedly wielding a knife when police shot him.
"[The halfway house staff] said he had graduated," she explains. "They told me, 'Why are you trying to hold him back?' They belittled me for being concerned. They told me there wasn't any more funding [for him] for that level of care. They don't pay for ongoing care in a halfway home if you're not sick enough to be in a hospital."
Nowhere to Go
Sonoma County's mental healthcare system made headlines recently over the closures of two acute psychiatric inpatient facilities. Last June, the county shut down Santa Rosa's Psychiatric Emergency Services, known more familiarly as the Norton Center, saying it was losing $2 million to $3 million a year because the average daily population had dropped to less than half the facility's capacity. And this February, Santa Rosa Memorial Hospital closed its psychiatric hospital on Fulton Road, claiming $22 million in losses.
That leaves the county with no inpatient care for people facing acute mental health problems. The county provides emergency care at Norton for 23 hours or up to three weeks in a six-bed halfway house. After that, it sends patients to Marin General in Greenbrae and two Seventh-Day Adventist-run hospitals in St. Helena and Vallejo.
To fix the problem, the county has initiated roundtable discussions with representatives from local hospitals. The two alternatives being considered are a 60- to 84-bed regional hospital at the Fulton Road facility, which would be run by a private company, Psychiatric Solutions, or a 16-bed hospital at an undetermined location, which would be shared by Kaiser Permanente and the county. Norton is too costly to retrofit, says Art Ewart, Sonoma County's director of mental health.
Sonoma County isn't alone in facing a broken and bleeding mental healthcare system, says Rosemary Milbrath, director for the National Association on Mental Illness Sonoma County, who estimates that California has lost 700 mental health beds in the last year. And, she adds, it is a nationwide trend.
Part of the loss can be attributed to new, noncustodial ways of treating those with mental illness, but a lot of it comes down to lack of money. Ewart says that the state's mental health budget is underfunded by 50 percent. Locally, that means one worker is generally responsible for 30 to 40 clients. Ideally, Ewart says, it should be a 10-to-1 caseload.
"The people we serve in the community are not getting sufficient treatment," he says.
According to retired county mental health worker Marty Gerber, mental health services in California were at their peak in 1982. Since then, it's all been downhill, with clients and overworked clinicians paying the price.
One program falling victim to funding loss was a mobile crisis unit that teamed mental health workers with police officers. Sonoma County tried it for six months a decade ago but dropped it when the money ran out.
"It's difficult to prove a program like that works," Ewart says, who was there when it happened.
But mobile units seem to be doing their job in San Mateo County and in Berkeley, where such a program has been in place since the 1970s.
Officer Andrew Frankel of the Berkeley Police Department agrees that it isn't possible to prove for certain that the city's Mobile Crisis Response Unit makes a difference, but he says his fellow officers consider the mental health workers "valued members of the team."
"We work hand in hand," he says. "They come to the roll calls at the change of shift twice a day [when officers debrief their shifts]. They are a great resource for us. We can call for help anytime there is erratic behavior from a suspect. It is nice to get on the radio and have a subject-matter expert show up at the scene."
While there may be no way to determine if the Mobile Crisis Response Unit has been a factor, Frankel says that there haven't been any police-involved killings in Berkeley in the eight years he has been on the force.
"It's become part of the way officers act with cases," says therapist and mobile crisis unit member David Wee.
The unit is on call from 11am to 11pm every day. Members carry police radios so they can either do joint response to calls with the police or be available for consultation and backup.
Police can also use the radios to keep tabs on mental health workers when they respond to a situation on their own. According to Wee, emergency dispatch refers about half of the incoming calls for help directly to the unit. But when there is the threat of violence, police show up first and the mental health workers "provide the response once the situation is safe."
Police and Mobile Crisis Response Unit members can also work together to help people with mental health problems before they reach a crisis.
This kind of close cooperation between law enforcement and mental health workers is also the key to the success of the San Mateo County Mental Health Assessment and Referral Team (SMART) in the South Bay.
The team is made up of specially trained paramedics who can assess a person with apparent mental health problems, place her on a 72-hour hold if necessary and escort her to the county's inpatient psychiatric facility.
"Basically how it works," says Teri Wilcox, clinical services manager for SMART, "is somebody calls 911, the operator calls a police officer to respond. The officer assesses the situation and calls for a SMART paramedic if it is a code 2 [nonviolent] situation. The SMART paramedic arrives, talks with the person, consults with a mental health clinician or psychiatrist by phone, and then recommends what action should be taken. If the paramedic decides to take the person to a hospital or other facility, he or she provides the transportation in a special vehicle."
The Assessment and Referral Team is on duty 24/7, and there are always mental health clinicians on call for consultation.
The county's mental health department also provides crisis-intervention training for officers so that they can better respond to suspects with mental health problems.
"One of the main things about the training is to help the officer understand what's going on with the patient. It teaches the officer to react with words and compassion," Wilcox says.
In addition to working together in the field, officers, mental health clinicians and other agencies also meet monthly to "discuss difficult cases" and find solutions.
"It really helps when law enforcement and other groups work together to help people turn their lives around," Wilcox says.
Several officers in the Santa Rosa Police Department and the Sonoma County Sheriff's Department, and one from Healdsburg, recently participated in the same training. Wilcox says Mike Kennedy of the Sonoma County Mental Health Department took the training in San Mateo and then brought it back.
The county paid for the training with MHSA money, according to Kennedy, who plans on continuing the three-day training sessions with other police departments in the county.
"If over the next couple of years we can train 300 officers, it would make a big difference," he says.
Taxpayer, Tax Thyself
Officers schooled in responding to people with mental illness would fill some of the gaping holes in a structure that is in serious need of repair. But the mental healthcare system still needs more money, and retired county mental health worker Marty Gerber, who worked within the system for 20 years, has a plan. Sonoma County residents should tax themselves for mental health services like they do for open space acquisition.
"I believe a one-quarter of 1 percent sales tax will take care of many, if not all, of our mental health services financial woes," he wrote in a letter to Sonoma County supervisors. "Terminating or privatizing services will not solve our problems."
Gerber believes voters would be willing to pay if supporters mounted a serious campaign, door-to-door and at shopping malls. Family members of the mental health patients killed by police would put a human face on the campaign by endorsing it.
Meanwhile, at least one supervisor is trying to drum up cash in another way. Sonoma Valley supervisor Valerie Brown, who is also a licensed therapist, went to Washington, D.C., in March with a group from the National Association of Counties to lobby for more mental health dollars.
She said the U.S. Department of Justice "isn't aware of the sheer number" of mentally ill inmates and the importance of more and better mental health services to keep them out of jail." So she gave them the facts and the figures.
"Our hope is the federal government will see what is going on and will provide money to treat the mentally ill outside the jails," she says, still not knowing if her efforts paid off in cash.
Through it all--the budget shortages and the screaming headlines--mental healthcare providers have organized on their own to make the system better.
Stella Rijeka is the coordinator for the four-year-old Mental Health Coalition of Sonoma County. Her regular job is in the community benefits department of Santa Rosa Memorial Hospital, and the time she spends with the mostly volunteer coalition is her boss' in-kind contribution to the effort.
Rijeka says that the coalition has been organizing a website and a social marketing campaign in the hopes of making mental health services more accessible to the public and removing the stigma that mental illness carries in the community. The group has created binders with a list of mental healthcare resources for distribution to hospitals, clinics and other healthcare providers. The list will be posted on the coalition's website this summer.
The coalition is also organizing a series of public forums in the fall to bring together everybody in the county involved in mental healthcare to tie together the loose and fraying ends of what it calls "the continuum of care."
"We want to shift people's consciousness," Rijeka says. "When we say mental health, we mean health, not illness."
The American Psychiatric Association lists these as signs that adults may be experiencing the onset of mental illness:
For signs specific to children and teens, visit the website at [ http://www.healthyminds.org/warningsigns.cfm ]www.healthyminds.org/warningsigns.cfm.
Looking for Help?
A Clip 'n' Go guide
With so much conflicting information on Sonoma County mental health services, here is a short list to hang on to in the unfortunate event that you or a loved one suffers a crisis.
Sonoma County Psychiatric Emergency Services County officials say that nobody will be turned away from this county-funded psychiatric center. Provides evaluations and referrals. 3322 Chanate Road, Santa Rosa (near Sutter Hospital). 707.576.8181 or call 911.
Kaiser Permanente The emergency room offers psychiatric evaluation to members and nonmembers alike. 401 Bicentennial Way, Santa Rosa. 707.393.4000.
Santa Rosa Memorial Hospital The emergency room provides psychiatric evaluation for everyone. 1165 Montgomery Drive, Santa Rosa. 707.546.3210.
There are no inpatient facilities for psychiatric patients in Sonoma County.
The county sends its patients to Marin General Hospital (250 Bon Aire Road, Greenbrae; 415.925.7663) or to Adventist Health at St. Helena Hospital in St. Helena (710 Woodland Road, St. Helena; 707.963.3611) or its Center for Behavioral Health in Vallejo (525 Oregon St., Vallejo; 707.648.2200).
Sonoma County Community Mental Health Centers Four sites offer psychiatric appointments for on-going treatment, including medication. For Guerneville, call 707.869.4007. For Petaluma, Sonoma or Cloverdale, call 707.769.5270 or toll-free 1.887.700.5270.
Redwood Community Health Clinics Independently operated regional health centers offering general healthcare, including psychiatric and psychological treatment, on a sliding scale. They also take Medi-Cal and Medicare. Healdsburg, Alliance Medical Center, 707.431.8234. Petaluma Health Center, 707.559.7500. Sonoma Valley Community Health Center, 707.939.6070. Southwest Community Health, Santa Rosa, 707.547.2222. West County Health Centers: Guerneville, 707.869.2849; Occidental, 707.874.2444.
Santa Rosa Free ClinicVolunteer-run clinic offers free, drop-in, healthcare including psychiatric care two days a week, as well as other services. 465 A St., Santa Rosa (in the Catholic Charities family shelter). 707.546.6479.
Lomi School Foundation and Psychotherapy Clinic Interns provide sliding-scale psychotherapy by appointment, offering a combination of talk therapy and bodywork. 534 B St., Santa Rosa. 707.579.0465.
Chrysalis Counseling Services for Women Interns provide sliding scale psychotherapy for women. 1821 Fourth St., Santa Rosa. 707.545.1670.
Social Advocates for YouthThe center offers psychotherapy and many other services, including 24-hour crisis intervention, for youth dealing with homelessness, addiction, mental illness and any other situations that puts them at risk. There are services in Santa Rosa, Sonoma and Healdsburg. 707.544.3299.
Petaluma People Services Center This agency offers psychotherapy on a sliding scale and many other services. There are Spanish-speaking counselors on staff. 1500-A Petaluma Blvd. S., Ste. A, Petaluma. 707.765.8488.
Family Service Agency of Sonoma County Nonprofit offering mental health and other services on a sliding scale. 751 Lombardi Court, Santa Rosa. 707.545.4551.
Russian River Counselors A private nonprofit offering psychotherapy and group counseling for children and adults on a sliding scale. It also accepts Medi-Cal and Medicare. 19375 Hwy. 116, Monte Rio. 707.865.1200.
Peer Support Centers
Russian River Empowerment Center A drop-in center offering classes and support groups. It is staffed and run by peers. 16229 Third St., Guerneville. 707.604.7264.
Wellness and Advocacy Center This is a peer-operated drop-in center with groups and classes for the seriously mentally ill under the aegis of Goodwill Industries. Programs are in both English and Spanish. 3400 Chanate Road, Santa Rosa. 707.565.7800.
Interlink Self Help Center Also connected to Goodwill Industries, this center provides classes, peer support, advocacy and other services to the seriously mentally ill. 1033 Fourth St., Santa Rosa. 707.546.4481.
Having Your Say
Public hearings and meets
Sonoma County Mental Health Board This board advises the county's mental health department. It includes providers, consumers and other interested people. It meets the third Tuesday of each month. The July 15 meeting will be held in Guerneville. Call 707.565.4854 for details.
Mental Health Services Act The planning groups for determining how to spend the county's Proposition 63 meet at Santa Rosa's Glaser Center. For dates and times, call 707.565.4854 or go to www.sonoma-county.org/health.
Mental Health Coalition of Sonoma County This volunteer group composed primarily of mental health providers is planning a series of community forums in the fall. Stay tuned for dates, times and locations.
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